Episode 20 - HEAL Urgent Care

In this episode, Scott Lynch (Managing Director of Community Therapy) speaks with Tim Stewart (CEO & Medical Director of HEAL Urgent Care).

HEAL is a walk-in urgent care clinic for non-life-threatening injuries and illnesses, with the goal of providing excellent care for patients while easing the burden on public emergency departments. Scott and Tim discuss how HEAL Urgent Care was built from the ground up - from ideation to the first week of operation.

We hope you find this insightful and inspiring!

Resources
HEAL Urgent Care Website
HEAL Urgent Care Facebook
HEAL Urgent Care Instagram
HEAL Urgent Care LinkedIn
Tim's LinkedIn

Community Therapy Website
Community Therapy YouTube
Community Therapy Facebook
Community Therapy LinkedIn
Scott's LinkedIn

Takeaways

• HEAL aims to bridge the gap between general practice and the hospital, providing an alternative for patients who don't need hospital-level care.
• Prioritising an excellent consumer experience leads to better health and business outcomes.
• The clinic offers a comprehensive range of services, including X-rays, pathology, wound repair, fracture management, and more.

Timestamps
(0:00) Intro and Tim’s Background
(4:15) The Journey of Setting Up HEAL Urgent Care
(14:46) Importance of Innovation and Consumer Experience
(24:58) The Scope of Care at HEAL
(35:14) Medicare Urgent Care Clinics and HEAL’s Relationship With The Public Sector
(41:33) Challenges and Opportunities for HEAL
(49:52) Final Thoughts and The Future

Transcript

1:38

Thanks so much, Scott. I'm really, really excited about talking to you today. Thanks so much for having me. I'm good today, thanks Scott. A rarity where I'm not in the clinic. And so I'm at home on my balcony, looking out over the district with my dog Stanley sitting at my feet. So today's a good day. And yeah, I think running a business is stressful and it's really a first for me, but emergency departments are stressful too. And hospital systems are under stress, which impacts, you know, the ability to provide excellent service and do as much as we want to do for people and as much as we know we can do for people. And I think that sort of brings it back without going on too much of a tangent, it brings it back to why we set up Heal in the first place. to provide a better alternative for people than going to an emergency department and to do it with exceptional five-star service. And combining those two has just been a magical formula that the success of the business is unbelievable. And we are offloading public emergency departments and providing a better alternative. So, you know, it's really just filling that. gap between general practice and the hospital that until now was quite a large gap and we're doing our bit to support people and keep them in community. I'm going to go ahead and close the video. Yeah, well, it's a long story. And it was two years in the planning before we opened the doors. And we've just had our first birthday. So there's three years of work. And yeah, of course, prior to that, the idea originated at a conference, actually, I went to a pediatric conference in the States about seven years ago, and heard about the concept of virgin care. And their perspective is a standalone independent clinic that services the need of the community and provides a cheaper and a better alternative to going to expensive hospital systems and emergency departments. And I reflected on this at the time and I thought, well, hang on. So we know that emergency departments in Australia discharge 70% of patients that present there the same day. So most of those 70% of people don't actually need hospital level care and could be supported in community with the appropriate infrastructure and staffing skill mix. And so at the time I really had zero capacity to do anything. Both of our boys were just babies. Life was taken up with changing nappies and doing bottom up. doing bottles, harrowing times. But, you know, as they sort of grew up, yeah, it's tough. It was definitely tough. And I was juggling three different rosters at the time as well. So I was working at the John Hunter and also on board the Westpac helicopter and then doing shifts at Lake Macquarie private emergency department. And really sort of through a combination of a culmination, I suppose, of my skills and experience working across a diverse range of populations, demographics across Australia. I spent time working in New South Wales, Queensland, Alice Springs, Perth. And some of that time has been spent in the private system. innovate and change within the public health system, because I was just a little fish in a big pond. And it seemed like the longer I was in that role as an emergency specialist. So running, you know, Maitland, John Hunter, emergency departments, ensuring flow of patients into the hospital and safe discharge home. But I guess after a while you sort of just rinse and repeat and it's the same every day. And I felt constrained in that system. Like I had a lot more energy and motivation to do much more, but I wasn't able to do it internally. And so to build a standalone independent clinic that can function in community and bridge that gap between general practice and the emergency department required. an approach of basically starting from scratch and building a business from scratch based on a concept and an idea that a really strong passion and totally 100% committed that this was going to solve some of the crisis and some of the problems facing public hospitals and to divert patients and keep them. in community when they can be safely and effectively managed there. So that was really where I took it to mentally and then some years later when the boys were approaching school age, that I realized if I could play around with my public fraction and reduce my commitments. And we had some savings that we could use to kind of support us while we develop the business model. And that was really developed through combination of different people, including primarily Jason Carney, who's our director of nursing is nurse practitioner. He's been working at the John Hunter for many years, is really at the top of his field when it comes to emergency nurse practitioner, and has developed the training program for nurse practitioners at the John Hunter Hospital and was and was actually the first pioneer of that program. So an excellent clinician and also sites set on a better alternative for patients and understanding that we can provide this service and community. So Jason and I workshopped over six months about how this would look and what we would need in terms of infrastructure and staffing and equipment resources. And meanwhile, I was working in the background, working on funding and financial the aspects of it. And then I met Gavin Rose, who is our non executive director and has 20 years of experience in building healthcare infrastructure, specialises in financial modelling for clinics like this, and has a background in finance, originally in Sydney. So meeting development because he was able to tap into funding resources, generate partnerships, for example, Hunter Imaging Group, Labrador Pathology, and also was an expert on building on infrastructure and has built multiple GP clinics around the Newcastle and Hunter region, is working on a day hospital in Charlestown currently. and was able to help us basically secure the lease for the property that we're in at Paris Street and get the financial model to stack up. So that all happened cohesively together and then it was about finding the site, which we did, in Paris Street as I said, and then the fit out. with the vote projects, which was amazing experience. They did a great job. No one had really designed urgent care before, certainly not in this region, and the vote project was the first for them. So they were saying, well, what does an urgent care clinic look like? And Jason and I were, well, we don't know, because we've never built one and there isn't really one. There's a scattering of examples around Australia. But we knew we had the opportunity to build it how we thought it should be built. And that, you know, is large enough to deal with volume and capacity. And we can see over 100 patients a day in each clinic. So that's 35,000 patients a year in each clinic. And, you know, as an example, Maitland Hospital sees 50,000 a year. So that's the sort of volume we were looking to see. And then we needed the equipment that goes with running a clinic like that. So X-ray machines on site. It's really a first for our region to have availability or access to plain X-ray after hours on a Saturday and a Sunday. So I'm partnering with Hunter Imaging. They made that really easy for us. And we've got a radiologist and a portable x-ray machine on site every hour that we're open. And similarly with Laverty, the concept of blood gas analysis or rapid blood analysis in community. I mean, these are really expensive machines that are normally only found in an intensive care setting or a tertiary emergency department like the John Hunter. And now we have them in our clinic and community, which can provide a... a whole array of blood results in under three minutes, which is just amazing. So we can make clinical decisions on that, and we can decide how best to treat people in the clinic, and we can also let them know if their illness is so serious that they need to go to hospital for admission. And we have other toys as well. We have a slit lamp for looking in eyes, and a point of care ultrasound machine for doing scanning. in certain circumstances. And we have an isolation zone for containing respiratory and infectious diseases. We see a lot of COVID and RSV and we do that really safely. And then we have a procedure room where we do all the painful stuff to people, wound repair and closure and fracture management, those sorts of things. And thinking about... How can we build this clinic to provide the most amount of care for people and keep them out of hospital and do it safely? And so huge amounts of innovation happening at Heal just in setting it up. And some examples I've already given and another one was about well, Patients often end up in hospital because they've got a bent forearm or a fracture that needs sedation and management, usually under anesthetic in the emergency department. And how can we, because we've got the skills to be able to do that, but how do we get the conditions to do it safely with a compliant patient that's not screaming in pain and we're managing that effectively. And so we've brought. the green whistle into heel, which ambulance have been using for years safely in community. But it's the first that I'm aware of where it's been used in a clinic with emergency physicians and a utility in fracture management to keep people out of hospital and also kids with forehead and chin lacerations. We see a lot of that. And we've successfully... essentially sedated kids as young as two years old to fix their faces and put stitches in. And those patients, they go to an emergency department and they roll around for hours because it needs that sedation. And that requires a resource bay and a senior clinician and a whole set of criteria, which often aren't available at short notice and often. those patients will be asked to return them the following morning fast. And we're getting them in and out in 90 minutes, which is just amazing. And they have the best experience and they get their lollipop when they're done and off they go. So that... Yeah, well, everyone loves the drinks and snacks. That's been a massive hit. The sparkling water on tap, Scott, I never thought it would be such a... popular item, but everyone raves about it. Well, yeah, and that was sort of the other part of the business. I mean, patients are really surprised when you offer them Panadol and Urefin and ask them if they want still or sparkling water with that. And we're constantly surprising people at the level of service that we provide. And, you know, from a financial model, I guess it boils back to the... the point that people pay for the service because we are privately funded, so we don't have access to any form of government funding or grants. And there's various reasons for that. But essentially, yeah, we funded the clinic privately, we have investors, and to provide that level of service, the cost is $295, which includes everything. And there's a Medicare rebate available with that as well, so they're out of pocket. is some about 50 or 100 bucks less than that. So yeah, that's complete assessment, investigations, x-ray pathology, and any sort of treatments, intravenous medications, and then procedures as well. So wound management, fracture management, and then we throw in the boots and crutches for free and the splints and slings. and people walk out the door and they know they've got nothing more to pay and they're going to get a kickback from Medicare as well. So given the fact that they're paying for the service, we wanted to provide a five-star service. And just noticing generally in Australia that service is dead. You know, I think when you go out for coffee and breakfast in the morning and you just see it that most people haven't experienced five-star service, I think. And so when they come to heal and they experience that, they're really surprised, particularly in a medical setting. Yeah. Ha ha ha. Yeah, and I think when you've got a... Yeah, you know you've got a good business idea when everyone asks, well, why is no one else doing this? This sounds like a great idea. And we couldn't answer that question. It was just basically down to the fact that, I guess no one... I've done it or as I say, there are a few examples and really I can't take credit for pioneering urgent care in Australia, but certainly in our region, it's a first. And the FACEM led, the emergency position led model is really embryonic at the moment. There's a clinic in Sydney and the Gold Coast and there'll be more coming. But I looked at those clinics and And Pankaj, who's the director of WISE in Sydney, he's a friend of mine. And I thought, well, if these guys can do it, I can do it. You know, what's so different about them to me that would mean that I wouldn't be able to do this? This is really my area of expertise from a clinical medical perspective. And so with Jason, you know, at my side, we're able to build this, the medical side of it. And then with the other people on the team, you know, we can figure out the rest. And so Gavin for the financials, and now we've got Alex as the business and operations manager, and Nico as the people experience manager. And yeah, of course we all need each other and it's, you know, the sum of all our parts that is heal. So getting the right people on your team, of course is critical and having them. aligned with the vision. But it's a pretty easy vision to align yourself with because everyone sees the benefits for community and we're offloading public hospitals. So it's a win-win. I think, you know, we're really delighted with the progress that we've made since we've opened and it's really proved, like you said, at that meeting that you were at recently, it's really proved that we've... We've ticked the boxes for quality and five-star service. And the medical model is working really well in terms of how we, well, the level of care we can provide and also the aftercare, the follow-up after people leave the clinic is just next level. It just hasn't been experienced before. And that again is through these partnerships that we have with people like Hunter Imaging Group. the orthopedic surgeons that have partnered with us. You know, we have six orthopedic surgeons providing on-call support for HEAL and also running our weekly fracture clinic, hand therapy service, hand surgeons, lots of specialists actually, really keen to be involved in community and help us support these people. So that aspect of the business has been great to see how well And that actually did, I mean, it was obviously in the planning, but it actually did seem like it just fell into place. And I was really surprised at how well it ran from the from the beginning. And so, yeah, we're delighted with the progress that we're making there. Yeah, so we're open to the public as a walk-in clinic. So you don't need a referral or an appointment. You don't need to be in a private health fund. And what we see is the same breadth and scope that you would find in an emergency department and we'll treat. anything that walks in the door, unless it's life threatening or, you know, it needs to go to hospital for admission. So we're actually providing complete care for about 96% of the patients or the people that walk in our door and we're treating them safely in community. And there's a small cohort of people that need to be admitted to hospital or need more urgent investigation than we can provide. And so we... We do that assessment straight away and let them know where they should go for their care and how to get there safely, whether it's by private car, we call an ambulance. But all of those 96% of people that we treat, about half of them are injuries and the other half are illness. So we see lots and lots of injuries and many of those are sports related and also kids. skateboards, trampoline parks, ice skating rink, you know, all the stuff that kids love to get up to and also the adults then join in and then they fall off the skateboard or you know, yeah, lots of cycle accidents, electric scooters etc. Where there's, you know, an injury to a body part, potentially a fracture, And we manage that really effectively and we're experts at doing that and doing it well. And the other 50% is illness. And illness is respiratory most commonly and also kids and babies. And those would probably be the top three, would be injuries, respiratory and kids and babies. But there's other forms of illness as well. fluid replacement, advanced infection that needs intravenous antibiotics, eye problems, ear, nose, and throat problems, gynae issues, infections, STDs. There's, yeah, a really broad scope. Anything that's not life-threatening, we can treat it heal. So it really is an end-to-end service for people when they're. when they're in need of urgent care and it can't wait for a scheduled appointment with their GP. Yeah, well, yeah. Yeah, because a lot of injuries do happen at work. And the problem there is, it's a big issue for industry and businesses, is that they need access urgently to get an assessment for their worker. And most of them end up in the emergency department because there's nowhere else that they can get seen. And these injuries at work, they're often minor. It might be a finger laceration or a contusion or bruise. It might be a minor fracture, shoulder strain. Yeah, lots of musculoskeletal physiotherapy stuff and back strain, et cetera, rolled ankles, that sort of thing. So that's really just bread and butter for us. That's easy. And we now can provide the access. to employers where they can come to HEAL and these workers are covered by workers compensation, right? So they're not paying. And so the insurance companies are paying for the service. So no one's out of pocket. So when they turn up with their employer, that we can see them straight away. They got obviously the expert assessment and treatment that we've provided at HEAL. And then we discuss with them about the restrictions that are... that are going to need to be applied if any, and the time period that those restrictions will need to apply for them to safely recover at work. So I had an ankle sprain yesterday from a brick layer who was saying, I won't be able to go to work. And I went, well, you will because you'll have a boot on. Yeah, you won't be able to stand for long periods of time and you won't be able to walk long distances and you won't be able to be a brick layer. but you're still gonna be able to help the team and be present at work. And your employer, I'm sure, will find suitable duties for you to do. And the employer was like, look, he's an apprentice. He needs to do, he needs to catch up with his TAFE work. So he's gonna be at home for the next three days doing his TAFE work. And then we'll get him back onto site after he's had his physiotherapy assessment. And we'll work with them through the injury and we'll get him back to work. So aligning ourselves with... The benefits of workers recovering at work rather than being stuck at home where they get bored, fall into bad habits, it affects their mental health because they're socially excluded etc. actually prolongs the healing time for those workers to be at home unnecessarily. Well, talking of evidence, I think once a worker's been out of the workforce for longer than three months, the chances of them returning are less than 5%. And it's a massive problem. And so now we can provide the urgent access front end service, which otherwise would require potentially a six, eight hour wait in an emergency department, but also setting that worker up for recovery. putting the plan in place for ongoing follow-up and care from community services and ensuring that we complete that process. So we now have an aftercare clinic to follow-up work cover patients because they loved the service so much at Heal that they wanted to come back for follow-up. They didn't want to go elsewhere or... didn't want to go back to the GP. Some of them do, of course, and they're very welcome to do that. But most people were telling us that they wanted to, they wanted to continue with HEAL as their provider. And we're also not the regular, I guess, family health provider or general practitioner for these patients. So it's actually good in many ways to have a degree of separation between the two because there's no conflict of interest. So that's been a real success and now, you know, we just, I think we've got over a hundred contracts with various organizations and some of them are very large. I mean, the Hunter region, as you know, is full of industry and mining and shipping and trains and there's so much going on that and a lot of it is. I wouldn't say remote, but it's difficult to access health care, certainly on up the Hunter. And providing that service now is really groundbreaking and really catching on. So that's an area of growth for us. You know, it's one thing to rely on the man on the street to come in and put his hand in his pocket and pay for the care, but not everyone has 295 to do that. We totally get that. but when the worker is not paying out of pocket and it's all covered by insurance, it's just a total non-brainer. And we also then are. Yeah, so are we. We're delighted to work together. It's great. And yeah, I think the whole industry landscape will change as people catch on that the service is available. And we're just trying to keep up at the moment with some of that demand. And I'm looking at other ways that we can grow the business. Yeah, I mean, it was interesting how it all came about because we obviously started developing our model and were committed before we heard the announcement from government that they were rolling out the Medicare urgent care clinics. And so it's been really interesting to watch. I think there. You know, there are 50 or 54 clinics around Australia. In our region, there were two clinics earmarked for Cessnock and Tamworth, and another couple on the Central Coast. And the Cessnock Clinic has opened. We applied for funding for urgent care clinics because we were already open at that time. So, you know, you want to build an urgent care clinic, like we've already done it. And this is what it should look like. And this is how you do it. But government had a slightly different model, which was a GP-led model in existing GP infrastructure. So not a standalone independent clinic with purpose-built design like ours. And so we saw that as probably low volume and the fact that it was bulk-billed. and meant that it was going to attract people who wanted a quick free appointment with their GP. And I think largely that is what has happened. I think it's still great for community that they've got access to urgent care, but the lack of infrastructure funding, I suppose, and the staffing model that the clinics have is quite limited in terms of the volume and also the scope. Yeah, yeah. And some of the clinics don't have X-ray on site, for example, so that, you know, that when we're talking about 50% of people, you know, having injuries and needing an X-ray, that's a real restriction on the scope of practice. So I'm not convinced that these clinics are offloading emergency departments, but, But certainly our goal is to continue to do as much as we can in community. We weren't unfortunately eligible in the end for the government funding because the criteria were for existing accredited general practice and that's not what we are. So we missed out and that's an unfortunate sequence of events and just down to the timing again. But there are other opportunities within the public health system. that we're seeking to pursue. I mean, we built this clinic to be available to everyone, right? At the moment, the financial model is private and no funding. So people will need to pay for the service. But we can see public patients in our clinic with government funding. And that was actually what we proposed to government and to the LHD in a 40-page document. that we masterminded explaining with all the cogs and wheels about how this was going to work in terms of phoning an ambulance or being referred from general practice or being referred from an emergency department to our clinic and having X number of spots per day publicly funded and paid for by government. And that's still what we want to achieve. We're just trying to figure out how to do that. and to demonstrate, you know, I guess, now that we've been open for a year, we've got stronger data and we can start to build that case to say, we're here to help. We actually do want to offload ED and if people can afford to pay, that's great. But for people who can't afford to pay, government should pay. And to be honest, you know, we do it at a fraction of the cost of care in a hospital emergency department and people think... you know, going to an ED is free. It's not free. It costs a lot of money. Yeah. Hospital level care is super expensive. And a presentation at an emergency department is an average of $600. And we're doing it for less than half of that. So financially, we just feel that's the most socially and economically sustainable model is to have a hybrid system where we can see private and public patients under the one roof. So we're pursuing that. And we're also talking to ambulance because you know ambulance is, ambulance ramping in hospitals obviously a massive problem when you can't offload the patient and those ambulances are then not available for community when they need them. But we can offload those ambulances and many people who call an ambulance don't need to go to hospital. So it's about linking in with those services and. And developing the relationships, Scott, a lot of it is, you know, the ongoing conversation, the patience, the time, the trust that you need to develop and continue just sort of pushing, pushing what we know is the right thing to do for people and open up access to heal for everyone. Ahem. Well, I think, you know, we, as we grow, we're going to need more staff and some of the medical staffing, the medical workforce can be a challenge. It's difficult to change mindsets for doctors and emergency specialists, particularly who have spent their career working in a public health system to step out into community and do something different. So. We're constantly challenged by that, but as we move forward, more and more doctors are coming and choosing to come and work with us. I'm really excited by the engagement with general practice as well. Again, we have emergency physicians on the team, but we also have specialist GPs that really value coming to work in a procedural heavy, busy clinic like ours, where there's a real broad scope. and getting back to doing that wound care and fracture management and so on. They're really enjoying that as a break from the norm. So we're encouraged. We're encouraged by that. That there's a lot of growth still to do with the business and financially. We we we. Of course, we want to encourage people to come to heal. And so there's a lot of marketing promotion about the service. But most people hear about heal through word of mouth. So. That's Newcastle for you, you know, I think it's really important that, yeah, we just continue to provide that great service and people will keep talking about it. But also the work cover and the corporate cover that we're planning to provide an extended service for large organizations that would include a triage line, for example. and priority service on arrival and also a family benefits scheme for workers. So we're working through that at the moment. And then these ongoing discussions with ambulance and the LHD. And so those are not so much challenges. They're just part of the development of the model and allowing us to be successful in what we're doing. Because we know the model is successful, but to be financially successful, we still need to create, develop more of these opportunities. And one of the most exciting opportunities that we've got at the moment is with sports clubs. So we were heavily engaged with community. Last year during sports season, we were down at number two with our gazebo and handing out flyers and ice packs and lollies for the kids. And this year we sponsored four teams across the region and really engaging with those teams and listening to them about what some of the issues are that they have. So there's an education management piece there about when you need to call an ambulance to go to hospital and when you can come to urgent care. But there's also a big. push now within the sports clubs to safely and effectively manage concussion. And concussion in high impact sports is a big problem and it's obviously been quite topical in the media. And I think people are starting to realise now that, you know, they really need to follow the guidelines and to look after their players. And also parents are are tuned in to the risks of concussion and wanting the best for their kids and also themselves if they play sport. So we, as an injury management centre of excellence, are seeing concussion frequently. There'll be a lot more of it coming in the next couple of weeks when sport season fully kicks off. But Saturdays at heel are definitely the busiest day of the week. And concussion is something that we see a lot. It often doesn't need to be managed in an emergency department. And most concussion, although it appears quite severe initially, it does settle with time. And most of those people don't need fancy scans. You know, they need an expert assessment. And they need to be, we can tell them that they're safe to go home with their family and observation at home. But they don't need to go through a CT scanner most of the time. So we're providing that service in community and again, most of the time these people are being managed safely and effectively and being let home back into their homes with their family to recover there. So that in itself, I mean, that's just part of what we do. But the extension of that is that if people are signed off from sport, they need to be signed back on. And they need someone to follow the concussion injury, particularly if it's severe. So of course it's a spectrum and some people might just have a headache for a few days, that's very minor. But some people have chronic daily headaches that go on for months with difficulty concentrating, light sensitivity. episodes of dizziness and fatigue and they need ongoing care and follow up. And we're working out how we can provide that in an after care setting and provide the extension of this service because those concussion assessments do need some training and experience to complete and not everyone. not everyone is able to easily access that assessment and be signed back onto sports. So then they end up sitting out for longer than they need to. So we're working with a number of sports teams on that and I'm working on developing HEAL into a center of excellence for concussion management with the help of some of our doctors that have significant experience in that area in terms of follow-up. But also interestingly, and hot off the press this, so you're the first to hear, interestingly, we've got support from HMRI and unlikely funding as well for a research study into concussion in community and particularly in the pediatric, in the kids population. So that's super exciting where that's going. And again, like I just an absolute first for community to be able to have that level of care and assessment when it just hasn't been available anywhere else. And it's not even available in an emergency department because in an ED the decision is, am I gonna scan or am I not gonna scan? And if I'm not gonna scan, you're going home. And if I scan and get a normal scan, then you're still going home. So. It's just not the same depth of detail that we'll be providing for players when they have that type of injury. Well, we just really enjoyed our chat too, Scott. It's been great to reflect on where we've come from and what we've done over the last year. And I'm just really excited to see what the rest of this year holds. And hopefully we have more HEAL clinics opening. You know, this is not just a regional Newcastle problem that we're trying to fix. This is a national emergency department crisis and hospital health crisis. that we're trying to help solve. And so there's no reason why there shouldn't be a HEAL clinic in every large town in Australia. And so that is our goal is to revolutionize how urgent medical care is delivered in Australia. So it goes beyond just this region, but certainly as a hub for innovation and a starting point, I think it's, we're just really delighted with with how much we can provide for the region and the community. And I'm really looking forward to working with all of the stakeholders and partners in community just to develop the model further. Thanks Scott.